Questions in the CAHPS® Item Set for People With Mobility Impairments

Topic Item Number Question Wording Response Scale
Visit to doctor IM1 In the last 12 months, did you visit your personal doctor for care?
  • Yes
  • No
Being examined on the examination table IM2 When you visited your personal doctor’s office in the last 12 months, how often were you examined on the examination table?
  • Never
  • Sometimes
  • Usually
  • Always
Getting weighed at the doctor’s office IM3 When you visited your personal doctor's office in the last 12 months, how often did someone weigh you?
  • Never
  • Sometimes
  • Usually
  • Always
Difficulty moving around the restroom IM4 When you visited your personal doctor's office in the last 12 months, did you try to use the restroom?
  • Yes
  • No
IM5 In the last 12 months, how often was it easy to move around the restroom at your personal doctor’s office?
  • Never
  • Sometimes
  • Usually
  • Always
Pain IM6 In the last 12 months, did you and your personal doctor talk about pain? 
  • Yes
  • No
IM7 In the last 12 months, how often did pain limit your ability to do the things you needed to do?
  • Never
  • Sometimes
  • Usually
  • Always
IM8 In the last 12 months, do you think that your personal doctor understood the impact that pain has on your life? 
  • Yes
  • No
Fatigue IM9 In the last 12 months, how often did fatigue limit your ability to do the things you needed to do?
  • Never
  • Sometimes
  • Usually
  • Always
IM10 In the last 12 months, do you think that your personal doctor understood the impact that fatigue has on your life?
  • Yes
  • No
Getting physical and occupational therapy IM11 In the last 12 months, did you need physical or occupational therapy?
  • Yes
  • No
IM12 In the last 12 months, how often was it easy to get this kind of therapy through your health plan?
  • Never
  • Sometimes
  • Usually
  • Always
Getting speech therapy IM13 In the last 12 months, did you need speech therapy?
  • Yes
  • No
IM14 In the last 12 months, how often was it easy to get speech therapy through your health plan?
  • Never
  • Sometimes
  • Usually
  • Always
Using mobility equipment (Identifier) IM15 Mobility equipment includes things like a wheelchair, scooter, walker or cane. In the last 12 months, have you used any mobility equipment to move around your home or community?
  • Yes
  • No
Getting mobility equipment repaired IM16 In the last 12 months, did you try to get your mobility equipment repaired through your health plan?
  • Yes
  • No
IM17 In the last 12 months, how often was it easy to get your mobility equipment repaired through your health plan?
  • Never
  • Sometimes
  • Usually
  • Always
Getting or replacing mobility equipment IM18 In the last 12 months, did you try to get or replace any mobility equipment through your health plan?
  • Yes
  • No
IM19 In the last 12 months, how often was it easy to get or replace the mobility equipment that you needed through your health plan?
  • Never
  • Sometimes
  • Usually
  • Always
Ability to walk and/or difficulty in walking a quarter mile (Identifiers) IM20 A quarter mile is about 5 city blocks or 0.4 kilometers. In the last 12 months, were you able to walk that far?
  • Yes
  • No
IM21 In the last 12 months, did you have difficulty or need assistance to walk that far? 
  • Yes
  • No
Page last reviewed March 2016
Page originally created June 2013
Internet Citation: Questions in the CAHPS® Item Set for People With Mobility Impairments. Content last reviewed March 2016. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/cahps/surveys-guidance/item-sets/mobility/Questions-CAHPS-Item-Set-PWMI.html